Mentor Profile Form

Mentor Profile Form
Part 1: Please complete all sections of this form in order that the mentoring committee can learn as much about your background as possible. This information will be used only to pair you with a suitable mentee:
Current job role and responsibilities:
How long have you worked in this job? How long have you worked in the organization?
Knowledge, skills and abilities required to do your job (check those that apply):

InfluenceStrategic PlanningPlanning and OrganizationLeadershipMotivationDecision MakingOral CommunicationProblem SolvingWritten CommunicationDelegationStress ToleranceInterpersonal SkillsBusiness AttractionBusiness Retention & ExpansionEntrepreneurship/Small BusinessTarget Industry MarketingOrganization & Board DevelopmentRural Economic DevelopmentUrban Economic DevelopmentWorkforce DevelopmentUrban RenewalDowntown RevitalizationTalent AttractionTarget Industry & Cluster AnalysisTrade Show/Conventions/Recruitment TripsTaxes and IncentivesIndustrial Revenue Bonds
Other Technical Knowledge (list below)
What knowledge, skills or abilities do you believe you excel at (list from above)?
Educational Background?
Degree/School/Graduation Date
Degree/School/Graduation Date
Degree/School/Graduation Date
Hobbies and interests?
Part 2: Please answer the following questions as completely as possible. This information will be used only to pair you with a suitable mentee.
What do you hope to gain by being a mentor?
What are you looking for in your ideal mentee? What abilities, skills, personality, characteristics, and knowledge area would he/she have?
What are you hoping you can provide to your mentee? In what way or area can you help him/her the most?
How often do you travel out of state as part of your job?
What do you foresee as the major obstacle you will encounter in providing quality mentoring (e.g., time, availability, travel schedule, location, work schedule)?
Name

First NameLast Name
Organization
Email
example@example.com
Phone Number

Area CodePhone Number
Should be Empty:

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